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OTHER RELATED PHYSICIAN CERTIFICATE OF PROFESSIONAL LIABILITY COVERAGE THROUGH MUTUAL PROTECTION TRUST (MPT) Name of Worker: Tracy Lee, MD ✓ Type of Worker: Other Related Physician Employed by or related to the practice of the Member/Covered Entity: Cheshire Medical Corporation Membership # or Entity #: 5077 Effective Date: December 19, 2019 through December 31, 2020 Specialty: Occupational Medicine DBA(s): Procare Medical Walk In Inc Specialty: Occupational Medicine Procare Onsite Solutions Specialty: Occupational Medicine Procare Physical Therapy And Acupuncture Inc Specialty: Occupational Medicine Procare Urgent Care & Work Injury Specialty: Occupational Medicine Procare Work Injury & Urgent Care Specialty: Occupational Medicine Procare Work Injury Center Inc Mutual Protection Trust (MPT) will provide to the above -named Worker, the medical professional liability coverage described the MPT Agreement, Part 1, subject to all terms, conditions, and exclusions therein, and subject to payment of all obligations required thereby, for any Occurrence upon which the Claim is based, arising on or after the above -mentioned Effective Date, in the conduct of Professional Services by such Worker, provided that such Worker was acting within the course and scope of his or her duties and licensure as an actual employee of such Member/ Covered Entity at the time of the Occurrence. This Certificate of Professional Liability Coverage is not a contract of insurance or of liability protection services as between MPT and the above -named Worker and does not afford membership in the Cooperative of American Physicians, Inc. (CAP) to such Worker. This Certificate of Professional Liability Coverage does not amend, extend or alter the professional liability protection services afforded by the MPT Agreement to the above -named Member/Covered Entity. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this Certificate of Professional Liability Coverage may be issued or pertain, the medical professional liability coverage afforded by the MPT Agreement described herein are subject to all terms, conditions, and exclusions of the MPT Agreement. The limit of liability through MPT is $1 Million per Occurrence/$3 Million Aggregate. Such limit of liability is shared with the Member/Covered Entity. A shared limit of liability means that the Member/Covered Entity shares his/her limit of liability with the Worker for any Occurrence upon which a Claim against the Member/Covered Entity and the Worker is based. REVIEWED & APPROVED By Risk MANAGEMENT DIVISION .2020 ANGIE ACEVEdD